Trigger points – do they trigger headaches?

James23 October 2008

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Mayofascial trigger points (MTPs or TrPs) may cause the odd muscle pain. But what about headache? What about migraine? Is there really a relationship? If so, is it only in a few people, or is it widespread?

This is the second in our series on mayofascial trigger points. In part 1 – Trigger Points and headache – Fakery or Fact?, we found out what MTPs are, and we talked about how they may trigger headache or migraine. But could this be you? Let’s take a look.

Referred pain?

The first thing you have to remember about headache and MTPs is the concept of referred pain. You probably already know what it means – the source of the pain is in a different spot than where the actual pain seems to be coming from.

Then again, it might not be all that simple. What if a trigger point made you more susceptible to, say, a migraine attack? What if it just lowered your threshold?

Tension type headache

There are actually a whole host of things that can trigger the tension type headache reaction. Tension type headache (TTH) can be chronic, and can be seriously disabling. These headaches are usually a steady band of pain. We know things like insomnia, painkiller overuse, bad posture and caffeine withdrawal seem to trigger TTHs, but we’re still learning about why some people get them frequently and others don’t.

In fact, the whole idea that these headaches are caused by muscle tension is highly questionable – which is why they’re usually called "tension type headache" now.

It does seem that people with chronic TTH have more trigger points. There may be an underlying factor that contributes to both. However, there’s a good chance that massage of MTPs will help you if you have tension type headache, and may help you avoid a lot of pain if you have a chronic headache.

There’s more information about massage in general than MTPs in particular. A 2002 study found that massage of neck and shoulders made a significant difference (Massage Therapy and Frequency of Chronic Tension Headaches by Christopher Quinn, DC, Clint Chandler, BS, and Albert Moraska, PhD).

Migraine

In the first part of this series, I mentioned that a study in 1998 found a relationship between trigger points and the location of migraine pain. Massage of trigger points does seem to improve quality of life – especially helping with the daily headache migraineurs often get between attacks. It may be that trigger points are simply another migraine trigger – always there, sometimes worse and sometimes better, but also making you more likely to go over the edge when yet another trigger is added in.

A 2006 study (A randomized, controlled trial of massage therapy as a treatment for migraine by Lawler, S. P. and Cameron, L. D.) found that massage in general did help fight migraine attacks. And they noticed one more interesting thing – the massage also helped with sleep. Generally, if you can improve sleep you can cut down on the intensity and frequency of migraine attacks.

Cluster

As usual, cluster headaches are the least studied of these three. However, we do know that sleep problems are also related to cluster, as is oxygen deprivation in the body. Even if MTPs and cluster are not directly related, it seems likely that we can improve the situation for cluster patients by treating trigger points.

I would really like to see a long term study on this one, because it does seem intuitive that treating trigger points could make a significant difference.

The strange connection

One final note. Studies are showing a strange connection between "headache disorders" and trigger points. Quite simply, one seems to follow the other (though we don’t know who is following who!). People with headache or migraine tend to have more trigger points. If they have both tension type headache and migraine, even more. Plus, if the pain tends to be one-sided, the trigger points on that side are worse! (from Trigger Point Therapy for Headaches and Migraines by Valerie DeLaune, L.Ac.) Those with worse headaches tend to have more "active" trigger points (see this study for example).

We mentioned one more thing in our last report – it also seems that, the longer you have migraine, the more trigger points you get! Things seem to get worse over time.

These are reasons why some researchers believe that most people with headache or migraine can be helped with trigger point therapy (not cured – I’m saying their quality of life can be improved; less attacks and/or less severe attacks).

Conclusion (and coming up!)

There are a few studies showing that trigger point therapy can help, but we are looking for more studies to show how strong the relationship is, and what kind of therapy can help the most with each issue. Meanwhile, there is reason to believe that there is a strong connection between mayofascial trigger points and migraine, tension type headache, cluster, and other headache disorders.

In upcoming parts of this series, we’ll be exploring not only what kind of professional help to get, but how you may be able to help yourself – significantly.

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Great topic! I have associated my migraines with neck and shoulder pain since they started. For a while no doctor took that seriously. The first doctor that did was a specialist in TMJ. The physical therapy, posture changes, and bite splint helped. In the decade or so since then I have continued to try to determine if the muscles cause the headache or the headache the muscles. I tend to see the headache causing the muscle pain the most often. I have had trigger point injections and massage and they both seem to help. They knock out my other aura symptoms that I get (random odd neurological things). During one injection round my doctor asked me if I ever had whiplash. I haven’t. Never been in a wreck. I apparently have a lot of scar tissue. I also know that chiropractic was a migraine trigger as well.

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